The Balance between Open and Robotic Training among Graduating Urology Residents-Does Surgical Technique Need...

Area of Science:

• Surgical Education
• Minimally Invasive Surgery
• Medical Training

Background:

• Surgical residency programs require a minimum number of index procedures for graduation.
• Current training lacks clear thresholds for surgical technique, creating uncertainty about the balance between robotic and open surgery experience.
• Assessing the distribution of robotic versus open surgeries performed by residents is crucial for evaluating training effectiveness.

Purpose of the Study:

• To assess the distribution of robotic and open surgeries performed by residents upon graduation.
• To evaluate the balance of robotic and open surgical techniques in resident training.
• To identify trends in robotic and open surgery adoption across different surgical specialties.

Main Methods:

• Utilized de-identified resident case logs from the Accreditation Council for Graduate Medical Education across 11 institutions.
• Compared trends in robotic and open major surgeries using Wilcoxon rank sum and 2-sample t-tests.
• Analyzed a dataset of 89,199 major cases from 209 graduates between 2011 and 2017.

Main Results:

• The median proportion of robotic cases increased significantly from 2011 to 2017 across reconstruction, oncology, and pediatrics (p < 0.001).
• In 2017, robotic and open cases remained highly divergent in reconstruction (median 12 robotic vs. 70 open) and pediatrics.
• In oncology, robotic procedures surpassed open cases by 2017 (median 148 robotic vs. 121 open), driven by robotic prostatectomy.
• Substantial institutional and individual graduate variations in surgical technique distribution were observed.

Conclusions:

• While robotic surgery volume is increasing, the balance of surgical techniques and the rate of adoption vary across specialties and institutions.
• Significant differences among institutions and individual graduates raise concerns about training equity and standardization.
• The findings suggest a potential need for more specific guidelines to ensure consistent and equitable resident surgical training.